Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA, 02129, USA.
International Paralympic Committee (IPC) Medical Committee, Bonn, Germany.
Sports Med. 2017 Sep;47(9):1697-1708. doi: 10.1007/s40279-017-0696-0.
Low energy availability, functional hypothalamic amenorrhea, and low bone mineral density are three interrelated conditions described in athletic women. Although described as the female athlete triad (Triad), males experience similar health concerns. The literature suggests that individuals with a disability may experience altered physiology related to these three conditions when compared with the able-bodied population. The goal of this review is to describe the unique implications of low energy availability, low bone mineral density, and, in females, menstrual dysfunction in individuals with a disability and their potential impact on the para athlete population. A literature review was performed linking search terms related to the three conditions with six disability categories that are most represented in para sport. Few articles were found that directly pertained to athletes, therefore, the review additionally characterizes literature found in a non-athlete population. Review of the available literature in athletes suggests that both male and female athletes with spinal cord injury demonstrate risk factors for low energy availability. Bone mineral density may also show improvements for wheelchair athletes or athletes with hemiplegic cerebral palsy when compared with a disabled non-athlete population. However, the prevalence of the three conditions and implications on the health of para athletes is largely unknown and represents a key gap in the sports medicine literature. As participation in para sport continues to increase, further research is needed to understand the impact of these three interrelated health concerns for athletes with a disability, accompanied by educational initiatives targeting athletes, coaches, and health professionals.
低能量状态、功能性下丘脑闭经和低骨密度是三种在运动女性中描述的相互关联的情况。虽然被描述为女性运动员三联征（三联征），但男性也会经历类似的健康问题。文献表明，与健全人群相比，残疾个体可能会经历与这三种情况相关的生理变化。本综述的目的是描述残疾个体中低能量状态、低骨密度以及女性的月经功能障碍的独特影响，以及它们对残奥运动员群体的潜在影响。通过将与三种情况相关的搜索词与六个在残奥运动中最具代表性的残疾类别联系起来进行文献回顾。很少有文章直接涉及运动员，因此，该综述还描述了在非运动员人群中发现的文献特征。对运动员中现有文献的综述表明，脊髓损伤的男女运动员都存在低能量状态的风险因素。与残疾非运动员人群相比，轮椅运动员或偏瘫脑瘫运动员的骨密度也可能有所改善。然而，这三种情况的流行程度及其对残奥运动员健康的影响在很大程度上尚不清楚，这是运动医学文献中的一个关键空白。随着残奥运动的持续增加，需要进一步的研究来了解这些三种相互关联的健康问题对残疾运动员的影响，并针对运动员、教练和健康专业人员开展教育计划。
